epidural-catheter- assisting with insertion and care-1007 · pdf filepolicies &...

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Any PRINTED version of this document is only accurate up to the date of printing 3-Apr-12. Saskatoon Health Region (SHR)

cannot guarantee the currency or accuracy of any printed policy. Always refer to the Policies and Procedures site for the

most current versions of documents in effect. SHR accepts no responsibility for use of this material by any person or

organization not associated with SHR. No part of this document may be reproduced in any form for publication without

permission of SHR.

1. PURPOSE

1.1 To provide effective safe pain management using an epidural catheter for medication

administration.

2. POLICY

2.1 Patients having an epidural catheter inserted will be monitored and assessed as per

protocol based upon the type of epidural medication being administered.

2.2 Oxygen and resuscitative equipment must be readily available.

2.3 Monitoring and resuscitative measures are not required in the Palliative Care Unit.

3. PROCEDURE

3.1 Insertion

3.1.1 Supplies

•••• Mask, hat and sterile surgical gloves for anesthesiologist

•••• Epidural insertion tray

•••• Opsite® 10 cm x 14 cm

•••• Hypafix® tape

•••• Chlorhexidine prep 2%

•••• Medication (local anesthetic and/or narcotic) as requested by anesthesiologist

•••• Resuscitation equipment on unit

3.1.2 Encourage the patient to void prior to the procedure.

3.1.3 Establish an IV and obtain baseline vital signs.

3.1.4 Preload the patient with an IV crystalloid solution as ordered by the anesthesiologist.

Polices and Procedures

Title: EPIDURAL – CATHETER – ASSISTING

WITH INSERTION AND CARE OF

I.D. Number: 1007

Authorization:

[X] SHR Nursing Practice Committee

Source: Nursing

Date Revised: Jan 2010

Date Effective: June 2001

Scope: Saskatoon City Hospital

Royal University Hospital

St. Paul’s Hospital

Policies & Procedures: Epidural – Catheter – Assisting with Insertion and Care of I.D. # 1007

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3.1.5 Position the patient as requested by the anesthesiologist in side lying position or sitting

supported by a bedside table.

3.1.6 Assist the anesthesiologist as needed with epidural catheter insertion.

3.1.7 Support the patient during the procedure.

3.1.8 Assist the anesthesiologist in securing the epidural catheter over the insertion site and

up the patient’s back to shoulder with Hypafix® tape, ensuring there are no kinks in

the epidural catheter.

3.1.9 Ensure top of the catheter and connection adapter is visible and easily accessible.

3.1.10 Monitor vital signs and adverse effects of narcotic or anesthetic during injection and

immediately following injection according to protocol for type of medication(s) being

administered.

3.1.11 Following the procedure, position patient as ordered by anesthesiologist and

continue monitoring as per protocol.

3.1.12 Initiate treatment for adverse effects as per anesthesiologist orders. See Appendix A

or Appendix B.

3.1.13 Ensure use of an epidural infusion pump (yellow Gemstar) and epidural infusion tubing

(yellow stripe) with no ports. Ensure tubing and bag are labeled “EPIDURAL”.

3.1.14 Document on appropriate record

•••• epidural insertion time

•••• anesthesiologist performing procedure

•••• patient tolerance of procedure

•••• medication administered

•••• vital signs

•••• complications

•••• interventions

3.2 Care of Epidural Catheter

3.2.1 Check dressing over insertion site frequently.

•••• Do not remove the primary dressing.

•••• Observe for a wet dressing indicating leakage of blood or medication.

•••• Reinforce tape around dressing if necessary.

•••• If dressing saturated, notify anesthesiologist.

3.2.2 Observe the site for

•••• Redness

•••• Bruising

•••• Discharge

•••• Skin irritation or tape allergies

3.2.3 Check catheter

•••• Ensure the catheter is always securely taped.

•••• Be cautious when moving or turning the patient so the catheter is not dislodged.

•••• Check catheter tubing and pump connections for disconnection or kinking.


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3.2.4 If the catheter becomes disconnected from adapter call the anesthesiologist

immediately. No need to clamp.

3.2.5 No bath or shower while catheter in situ.

3.3 Report to Anesthesiologist

•••• Signs and symptoms of intrathecal injection of narcotic or anesthetic

•••• Postdural puncture headache

•••• Signs and symptoms of epidural abscess/infection

•••• Any abnormal loss of movement or numbness in legs or bowel/bladder incontinence

•••• Disconnection of catheter from connection adapter

4. REFERENCES

Assisting with insertion and care of epidural catheter. (June 2001) Tri-Hospital Nursing Policy and

Procedure Manual. Saskatoon Health Region.

Consensus-based guidelines for acute pain management using neuraxialanalgesia. (2008).

Canadian Anesthesiologists’ Society. Retrieved September 10, 2009 from

http://www.cas.ca/members/sign_in/guidelines/neuraxial_analgesia/.

Epidural analgesia. (February 2007). Clinical Policy & Procedures Manual. Sudbury Regional

Hospital, Sudbury, Ontario.

Epidural infusion. (January 2009). Children’s Pain Management Service. Retrieved April 30, 2009,

from Royal Children’s Hospital, Melbourne, Australia,

http:/www.rch.org.au/anaes/pain/index.cfm?doc_id=846&print=yes.

Failure modes & effects analysis (FMEA): The administration of epidural medications using PCEA

versus IV infusion pump. (October 2006). Risk Management, Saskatoon Health Region.

Protocol for epidural analgesia. (November 2008). St. Michael’s Hospital, Toronto, Ontario.

Weetman C. & Allison W. (2006, July 12).Use of epidural analgesia in post-operative pain

management. Nursing Standard, 20:44, 54-64.


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Appendix A


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Appendix B

SASKATOON DISTRICT HEALTH SASKATOON, SASKATCHEWAN

PHYSICIAN’S ORDERS ROYAL UNIVERSITY HOSPITAL (02) CITY HOSPITAL (03) ST. PAUL’S HOSPITAL (04)

� � �

ALLERGIES:

DATE TIME ORDERS AND SIGNATURE PROCESSED

_____ ___ INTERMITTENT EPIDURAL AND INTRATHECAL

NARCOTICS

TIME MAR

I CP

REQ

RN

1. Patient received: epidural/intrathecal

mg

or at hour

(DRUG) mcg

2. Monitor as per policy

3. NOTIFY ANESTHESIOLOGIST IF:

a) Patient somnolent, O2 Sat. less than 90%, RR less than /min

CALL STAT IF Patient UNAROUSABLE, give O2 at 10 L/min,

Monitor O2 Sat., and give Naloxone (Narcan) __________mg IV push

(Pediatric dose: 0.01 mg/kg)

b) Rescue analgesia required: Rescue analgesia mg

of IV push q

5. TREATMENT OF SIDE EFFECTS:

a) Pruritus: Diphenhydramine (Benadryl)________________mg IV push

May repeat q . (Pediatric dose: 0.5 mg/kg)

OR OTHER:

b) Nausea/Vomiting: Dimenhydrinate (Gravol)____________mg IV push

May repeat q . (Pediatric dose: 0.5 mg/kg)

OR OTHER:

c) Urinary Retention: Insert Foley Catheter

PHYSICIAN’S SIGNATURE ________________________________

Form # 102165 10/01 Category: Orders * EPIINT*

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